Intraarterial chemotherapy for retinoblastoma: the dosimetric impact.

Congress:

EuroSafe Imaging 2019

Poster Number:

ESI-0011

Type:

EuroSafe Imaging

Keywords:

Action 2 - Clinical diagnostic reference levels (DRLs), Action 7 - Radiation protection of children, Action 9 - Facilitation of research in advanced topics of radiation protection, Eyes, Interventional vascular, Catheter arteriography, Chemoembolisation, Cancer

Authors:

S. leonini, A. Guasti, P. Gennari, S. Cioni, I. M. Vallone, R. Baldi, E. Bertelli, S. Bracco

DOI:

10.26044/esi2019/ESI-0011

DOI-Link:

https://dx.doi.org/10.26044/esi2019/ESI-0011

Fig. 1: Six surface TLDs (sTLD)s were placed in a newborn phototherapy mask and on...

Fig. 2: Twelve dTLDs were placed within the phantom head (Fig. 2). Two TLDs were...

Fig. 3: Fluoroscopy times of each phase of IAC plotted as a function of the frequency...

Fig. 4: Estimated absorbed doses after single session of IAC by several organs and...

Background/introduction

Intra-arterial chemotherapy (IAC) offers the hope of eye salvage to children with intraocular retinoblastoma. It consists of locally delivered chemotherapy drug administration by direct catheterization of the ophthalmic artery (OA). When performed by an experienced team, IAC results a safe technique with mainly local and reversible side effects (1). Concerns remain regarding irradiation toxic effects from repeated fluoroscopy (2-4). This is particularly true for very young children (less than 1-year-old), with hereditary bilateral or multifocal retinoblastoma whose elevated risk for subsequent bone tumors, soft tissue...

Description of activity and work performed

Study population Starting from 2008 we treated 151 children (166 eyes) for intraocular retinoblastoma with a total of 782 IAC sessions. From August 2014 to August 2016, 44 patients (46 eyes with two bilateral retinoblastomas), 16 males and 28 females, have been treated at our Institution with IAC and included in this prospective study. Mean age was 35.4 months (range 9-227, median 28), mean cranial circumference was 49.6±3.2 cm. IAC received approval from the local hospital Ethic Committee. A multi-disciplinary group jointly discussed the opportunity...

Conclusion and recommendations

This study reviewed IAC procedure to provide a feedback to treating neuroradiologists and to check the adherence to the principles of radiation safety and ALARA. Notably, optimization of neurointerventional procedures is the most important step to take for radiological teams in order to reduce doses and maximize results as recommended by the European Commission (14). This study was also carried out as a part of a multidisciplinaryproject aimed to establish a diagnostic reference level(DRL) for this paediatric neurointerventional procedure, as recently recommended by the European...

Personal/organisational information

S.Leonini, Unit of Neuroimaging and Neurointervention, Azienda Ospedaliera Universitaria Senese, Siena, Italy Siena/IT,

References

1) Wyse E, Handa JT, Friedman AD, Pearl MS. A review of the literature for intra-arterial chemotherapy used to treat retinoblastoma. Pediatr Radiol. 2016 Aug;46(9):1223-33. doi: 10.1007/s00247-016-3554-6. Epub 2016 Feb 17. Review. PubMed PMID: 26886915. 2) Vijayakrishnan R, Shields CL, Ramasubramanian A, Emrich J, Rosenwasser R, Shields JA. Irradiation toxic effects during intra-arterial chemotherapy for retinoblastoma: should we be concerned? Arch Ophthalmol. 2010 Nov;128(11):1427-31. doi: 10.1001/archophthalmol.2010.258. PubMed PMID: 21060044. 3) Gobin YP, Rosenstein LM, Marr BP, Brodie SE, Abramson DH. Radiation exposure during intra-arterial chemotherapy...